引用本文:杨建荣,钟敬涛,刘天奇,杜阳春,韦所苏,殷 舞,凌 冰,唐耘天,黄永塔,董小锋.术前超声造影和术中快速冰冻病理切片诊断VETC癌巢型肝细胞癌的价值及患者手术方式选择研究[J].中国临床新医学,2021,14(3):262-266.
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术前超声造影和术中快速冰冻病理切片诊断VETC癌巢型肝细胞癌的价值及患者手术方式选择研究
杨建荣,钟敬涛,刘天奇,杜阳春,韦所苏,殷 舞,凌 冰,唐耘天,黄永塔,董小锋
530021 南宁,广西壮族自治区人民医院肝胆胰脾外科(杨建荣,刘天奇,唐耘天,董小锋),超声科(杜阳春,凌 冰),《中国临床新医学》杂志编辑部(韦所苏),病理科(殷 舞,黄永塔);250117 济南,山东省肿瘤防治研究院(山东省肿瘤医院),山东第一医科大学(山东省医学科学院)肝胆外科(钟敬涛)
摘要:
[摘要] 目的 探讨术前超声造影、术中快速冰冻病理切片诊断血管包绕肿瘤细胞巢(VETC)癌巢型肝细胞癌(HCC)的价值及最优手术方式的选择。方法 收集2013-10~2018-10经术后常规病理确诊的164例HCC的临床资料。免疫组化CD34染色观察VETC癌巢型、非癌巢型HCC形态学特点。统计癌巢型与非癌巢型HCC发生癌旁转移的比例。随访VETC癌巢型与非癌巢型HCC患者术后2年的复发率。分析解剖性肝切除与非解剖性肝切除对VETC癌巢型HCC患者术后2年复发率的影响。分析术前超声造影检查、术中快速冰冻病理切片诊断VETC癌巢型HCC的价值。结果 164例HCC中,VETC癌巢型HCC占40.24%(66/164),其癌旁转移发生率为30.30%(20/66),显著高于非癌巢型HCC的10.20%(10/98)(P<0.05)。VETC癌巢型HCC和非癌巢型HCC术后2年的复发率分别为53.33%和36.90%。在VETC癌巢型HCC患者中,解剖性肝切除可显著降低HCC患者术后2年的复发率(P<0.05)。术前超声造影诊断VETC癌巢型HCC的灵敏度为81.82%,特异度为91.84%,准确率为87.80%,与术后常规病理检查结果具有较好的一致性(Kappa=0.744,P=0.000)。术中快速冰冻病理切片诊断VETC癌巢型HCC的灵敏度为93.94%,特异度为91.84%,准确率为92.68%,与术后常规病理检查结果具有较好的一致性(Kappa=0.849,P=0.000)。结论 术前超声造影和术中冰冻病理切片可有效诊断VETC癌巢型HCC,解剖性肝切除是癌巢型HCC患者的优选术式。
关键词:  肝细胞癌  血管包绕肿瘤细胞巢  超声造影  冰冻切片  复发
DOI:10.3969/j.issn.1674-3806.2021.03.08
分类号:R 735.7
基金项目:国家自然科学基金项目(编号:81560406);广西自然科学基金项目(编号:2018GXNSFAA050118);广西区域性高发肿瘤早期防治研究重点实验室开放课题(编号:GXK201604)
The diagnostic value of preoperative contrast-enhanced ultrasound and intraoperative fast frozen pathological sections for VETC carcinoma nest-type hepatocellular carcinoma and the best surgical approach
YANG Jian-rong, ZHONG Jing-tao, LIU Tian-qi, et al.
Department of Hepatobiliary, Pancreas and Spleen Surgery, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Objective To explore the value of preoperative contrast-enhanced ultrasound and intraoperative fast frozen pathological sections in the diagnosis of vessels encapsulated tumor clusters(VETC) carcinoma nest-type hepatocellular carcinoma(HCC) and the selection of the optimal surgical method. Methods The clinical data of 164 HCC patients confirmed by postoperative routine pathology from October 2013 to October 2018 were collected. Immunohistochemistry(IHC) staining for CD34 was used to observe the morphologic features of VETC carcinoma nest-type/non-nest-type HCC. The proportion of paracancerous metastases in VETC carcinoma nest-type and VETC carcinoma non-nest-type HCC was calculated. The patients were followed up and the recurrence rates of VETC carcinoma nest-type HCC patients and VETC carcinoma non-nest-type HCC patients were investigated 2 years after surgery. The effects of anatomic hepatectomy and non-anatomic hepatectomy on the recurrence rate of VETC carcinoma nest-type HCC patients 2 years after operation were analyzed. The value of preoperative contrast-enhanced ultrasound and intraoperative fast frozen pathological sections in the diagnosis of VETC carcinoma nest-type HCC was analyzed. Results Among the 164 cases of HCC, 40.24%(66/164) of them were VETC carcinoma nest-type HCC, and the incidence of paracancerous metastases in the VETC carcinoma nest-type HCC patients[30.30%(20/66)] was significantly higher than that in the VETC carcinoma non-nest-type HCC patients[10.20%(10/98)](P<0.05). The recurrence rates of VETC carcinoma nest-type HCC and VETC carcinoma non-nest-type HCC 2 years after operation were 53.33% and 36.90%, respectively. In the VETC carcinoma nest-type HCC patients, anatomic hepatectomy could significantly reduce the recurrence rate of HCC patients 2 years after operation(P<0.05). The sensitivity, specificity and accuracy of preoperative contrast-enhanced ultrasound in the diagnosis of VETC carcinoma nest-type HCC were 81.82%, 91.84% and 87.80%, respectively, which was in good agreement with the postoperative routine pathological results(Kappa=0.744, P=0.000). The sensitivity, specificity and accuracy of intraoperative fast frozen pathological sections in the diagnosis of VETC carcinoma nest-type HCC were 93.94%, 91.84% and 92.68%, which was in good agreement with the postoperative routine pathological results(Kappa=0.849, P=0.000). Conclusion Preoperative contrast-enhanced ultrasound and intraoperative fast frozen pathological sections can effectively diagnose VETC carcinoma nest-type HCC, and anatomical hepatectomy is the preferred surgical method for patients with VETC carcinoma nest-type HCC.
Key words:  Hepatocellular carcinoma(HCC)  Vessels encapsulated tumor clusters(VETC)  Contrast-enhanced ultrasound  Frozen section  Recurrence